Preterm Birth Committee Report

Lord Weir of Ballyholme Excerpts

Friday 6th June 2025 Lords Chamber

[Lord Weir of Ballyholme (DUP)]

My Lords, I am only the third male Member of this House to speak in this debate, following on from the noble Lords, Lord Patel and Lord Winston, which, in addition to the other excellent contributions that have been made, gives me a slight feeling of being woefully inadequate to comment on this subject.

But I will start by commending what is an excellent report. While the scope of the report deals with England and Wales, the lessons that are drawn from it are applicable in all parts of the United Kingdom. It focuses on the two critical points, which are the incidence of preterm births and how we can optimise care for both the babies and their families in the days after birth.

It is critical because it goes to the heart of one of the two great nightmares that any parent can face. The second-worst situation for any parent is to be left in a situation in which your child is faced with a life-threatening condition, where you are left with weeks or months of trauma, not knowing whether your child will survive, not even being able to give that child comfort, and often then being faced with a situation in which that baby is faced with lifelong conditions. That is the second-worst situation for any parent. The worst situation, which sadly also pertains to a number of parents in preterm births, is the death of their child. There is no greater trauma that any parent can face, and that is why this this issue is so vital.

In the time available to me I want to look at three aspects of the report. The first is the incidence of preterm births. We are, thankfully, living in an era in which we have seen consistent improvement on a wide range of medical issues. No more so is that the case, over the decades and centuries, than for issues around birth and maternity. In human history, not that long ago, mortality rates for babies and mothers were extremely high. That applied not simply to those with socioeconomic problems but equally, quite often, to the most privileged and richest in the land. Thankfully, we have seen considerable improvements in that.

This is why the statistics produced in this report are quite worrying. As indicated earlier, a target was set 10 years ago to reduce the number of preterm births from around 8% to 6%, yet, in that 10-year period, figures have remained stubbornly high. Currently, the figure in England is 7.9%; in Wales, it is 8.1%. As indicated in the report, those figures mask further underlying problems, in the higher level of incidence for mothers from both lower socioeconomic backgrounds and ethnic minorities. The statistic is stark that a black mother is twice as likely as a white mother to have a very preterm birth. Similarly, the figures have not shifted for neurodevelopment issues.

As indicated, there is a multitude of reasons, of risk factors, for this. Mention has been made of smoking, drinking, mental health issues and diabetes. There is a wide range. One key aspect, on which I know the Government are focused, is the wider public health message, because a lot of these problems can be eased prior even to pregnancy taking place. We know the risk factors, but one of the areas highlighted in the report is the job of work still to be done, with greater levels of research, to work out the level of causality between risk factors and the end results.

Secondly, a wide range of screening, treatments and scanning takes place but, while new technologies can make improvements, we need to drill down in this area, with a much greater level of research, to try to make sure that what we provide prior to birth is the best possible situation to avoid preterm births.

A further area is the very welcome recognition that, while birth and the weeks after it are important, issues with preterm birth go well beyond that. It is important, particularly when we are looking at targets, that we acknowledge the number of cases where preterm births are medically induced, where it is both necessary and virtuous because it produces a better result for the mother and baby. However, we also know that around 75%—another statistic referred to in the report is 79%—of neonatal deaths are preterm babies. Beyond that, the figures also suggest that 46% of deaths of children under 10 were preterm babies. We know that, among preterm babies, there is a greater incidence of severe and milder disabilities, such as ADHD and cerebral palsy. The figures suggest that the incidence of children with severe brain injuries is around seven times higher than it is for babies who have gone full term. So there are important repercussions beyond the initial period in a neonatal unit.

The report is also very good at establishing some of the problems that are created not just for the babies themselves but for their families. We know that this can be a very traumatic experience and that it is rarely anticipated by the parents. Many mothers and fathers are left with a high level of anxiety—a traumatic period of separation when they are not able to give comfort to their children or hold their newborn babies. That can create a feeling of separation and alienation; the report indicates the number of parents who have PTSD as a result.

A point made very well in the report is that this is not simply in the first few weeks of birth but, as sometimes happens with trauma, can kick in much later, maybe months or even a year or two afterwards. It is clear that there are not necessarily the right levels of support for that. Counselling is also not always given to parents as follow-up support.

My third and final point, which is writ large throughout the report, is on the level of variations. While there has been a considerable improvement in the number of trusts embracing a bundle of interventions, there are still gaps. We need to work on best practice models, such as the PERIPrem model, and see where we can roll them out.

A range of other issues relates to that. The extent to which training can be given is sometimes dependent upon how much trusts are able to release staff, which varies. We have seen that family integrated care is not always universal, and some trusts, according to the report, water down that national guidance.

Beyond that, a range of staff shortages has been highlighted, from obstetrics to gynaecology departments to midwifery. Indeed, the gaps in terms of midwives also mean that there is no consistency of care.

Finally, as is highlighted in the report, we have also seen sporadic follow-up in, for example, the level of knowledge of health visitors, the position on two-year and four-year follow-up and the lack of counselling for parents.

So there is a lot to be done, and we need to see a greater level of consistency. One of the startling statistics highlighted in the report, which shows the need to further prioritise this issue, is that, for every pound spent on pregnancy care in this country, less than a penny is spent on pregnancy research. This report is a very good road map and I welcome the commitments that the Government have made but, if this is not simply to be an excellent report that gathers dust on the shelf, we will need to see those commitments turned into reality by the Government implementing the report.